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CORK Bibliography: Cognitve Therapy

91 citations. January 2005 to present

Prepared: March 2008

Arnedt JT; Conroy D; Rutt J; Aloia MS; Brower KJ; Armitage R. An open trial of cognitive-behavioral treatment for insomnia comorbid with alcohol dependence. Sleep Medicine 8(2): 176-180, 2007. (19 refs.)

Objective: We evaluated the efficacy of cognitive-behavioral treatment for insomnia in recovering alcoholic patients in an open pilot study. Methods: Seven abstinent alcoholic patients (3 women, mean age 38.6 +/- 10.8 years) recruited from outpatient and residential treatment facilities met the Diagnostic and Statistic Manual of Mental Disorders - Fourth edition (DSM-IV) criteria for insomnia comorbid with alcohol dependence and participated in eight individual treatment sessions. Participants were free of other medical, psychiatric, and sleep disorders. Daily sleep diaries were completed beginning two weeks before treatment until two weeks after treatment. Measures of sleep, daytime functioning, and drinking were collected. Results: Diary-rated sleep latency [F(2, 10) = 14.4, p < .001], wake after sleep onset [F(2, 10) = 7.7, p = .009], and sleep efficiency [F(2, 10) = 28.3, p < .001] improved as did patient-rated and clinician-rated Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep - Short Form (DBAS-SF). Compared to pre-treatment, significant post-treatment improvements were found on scales measuring depression and anxiety symptoms, fatigue, and quality of life. No one relapsed to alcohol during treatment. Conclusions: Cognitive-behavioral insomnia therapy may benefit recovering alcoholics with mild to moderate insomnia by improving sleep and daytime functioning. Effects on relapse remain to be determined. Findings need to be interpreted cautiously due to the uncontrolled design and lack of follow-up assessments.

Back SE; Gentilin S; Brady KT. Cognitive-behavioral stress management for individuals with substance use disorders - A pilot study. Journal of Nervous and Mental Disease 195(8): 662-668, 2007. (18 refs.)

Stress-induced craving and stress reactivity may influence risk for substance use or relapse to use. Interventions designed to attenuate stress-induced craving and stress reactivity may serve as excellent adjuncts to more comprehensive treatment programs. The purpose of this study was to (1) tailor an existing, manualized, cognitive-behavioral stress management (CBSM) intervention for use in individuals with substance use disorders and (2) preliminarily evaluate the effects of the intervention using an experimental stress-induction paradigm. Twenty individuals were interviewed and then completed a psychological stress task, the Mental Arithmetic Task (MAT). After this, participants were assigned to either the CBSM intervention group or a nontreatment comparison group. Approximately 3 weeks later, participants completed a second MAT. In contrast to the comparison group, the CBSM group demonstrated significantly less stress-induced craving (p < .04) and stress (p < .02), and reported greater ability to resist urges to use (p < .02) after the second MAT. These findings are among the first to report on the use of an intervention to attenuate craving and stress reactivity among individuals with substance use disorders. Although preliminary, the findings suggest that systematic investigation of interventions specifically targeting stress management in individuals with substance use disorders should be undertaken.

Baker A; Lee NK; Claire M; Lewin TJ; Grant T; Pohlman S. Brief cognitive behavioural interventions for regular amphetamine users: A step in the right direction. Addiction 100(3): 367-378, 2005. (29 refs.)

Aims: The present study sought to replicate and extend a small pilot study conducted by Baker, Boggs & Lewin (2001) which demonstrated that brief interventions consisting of motivational interviewing and cognitive-behaviour therapy (CBT) were feasible and associated with better outcomes compared with a control condition. Design: Randomized controlled trial (RCT). Setting: Greater Brisbane Region of Queensland and Newcastle, NSW, Australia. Participants: The study was conducted among 214 regular amphetamine users. Measurements: Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings: The main finding of this study was that there was a significant increase in the likelihood of abstinence from amphetamines among those receiving two or more treatment sessions. In addition, the number of treatment sessions attended had a significant short-term beneficial effect on level of depression. There were no intervention effects on any other variables (HIV risk-taking, crime, social functioning and health). Overall, there was a marked reduction in amphetamine use among this sample over time and, apart from abstinence rates and short-term effects on depression level, this was not differential by treatment group. Reduction in amphetamine use was accompanied by significant improvements in stage of change, benzodiazepine use, tobacco smoking, polydrug use, injecting risk-taking behaviour, criminal activity level, and psychiatric distress and depression level. Conclusions A stepped-care approach is recommended. The first step in providing an effective intervention among many regular amphetamine users, particularly those attending non-treatment settings, may include provision of: a structured assessment of amphetamine use and related problems; self-help material; and regular monitoring of amphetamine use and related harms. Regular amphetamine users who present to treatment settings could be offered two sessions of CBT, while people with moderate to severe levels of depression may best be offered four sessions of CBT for amphetamine use from the outset, with further treatment for amphetamine use and/or depression depending on response. Pharmacotherapy and/or longer-term psychotherapy may be suitable for non-responders. An RCT of a stepped-care approach among regular amphetamine users is suggested.

Baker A; Richmond R; Haile M; Lewin TJ; Carr VJ; Taylor RL et al. A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. American Journal of Psychiatry 163(11): 1934-1942, 2006. (38 refs.)

Objective: Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs, few studies have investigated the efficacy of smoking cessation interventions among this group. The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone. Method: The authors recruited 298 regular smokers with a psychotic disorder residing in the community and randomly assigned them to a routine care comparison condition (N = 151) or an eight-session, individually administered smoking cessation intervention (N = 147), which consisted of nicotine replacement therapy, motivational interviewing, and cognitive behavior therapy. Outcome variables included continuous and point-prevalence abstinence rates, smoking reduction status, and changes in symptoms and functioning. Results: While there were no overall differences between the treatment group and comparison group in abstinence rates, a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions (point-prevalence rates: 3 months, 30.0% versus 6.0%; 6 months, 18.6% versus 4.0%; and 12 months, 18.6% versus 6.6%). Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months (21.4% versus 4.0%). There was a strong dose-response relationship between treatment session attendance and smoking reduction status, with one-half of those who completed the intervention program achieving a 50% or greater reduction in daily cigarette consumption across the follow-ups, relative to less than one-fifth of the comparison subjects. There was no evidence of any associated deterioration in symptoms or functioning. Conclusions: These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions.

Beck JS; Liese B; Najavits LM. Cognitive therapy. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 474-501. (57 refs.)

The rationale for cognitive therapy is that thoughts, negative emotions and physiological response playing a major role in adddictive behavior. Cognitive therapists assess the development of patient's believs about themselves, their early life experiences, exposure to subtance,s the development of substnace-related beliefs, and their eventual reliance on substances. An important assumption is that subtance abuse is in large part learned and can be modified by canging cognitive-behavioral processes. The chapter addreses four key topics: cognitive case conceptualiztion, eight principles of treatment, treatment planning (with specific interventions discussed), and comparisons to other psycosocial treatments.

Berglund M. A better widget? Three lessons for improving addiction treatment from a meta-analytical study. Addiction 100(6): 742-750, 2005. (67 refs.)

Objective: To discuss how to develop more effective treatment programmes than those currently available for addictive disorders. Data sources: The Swedish SBU report, published in English in 2003, was used as a database. It includes 641 randomized controlled trials and seven longitudinal prospective studies. Methods: Meta-analytical calculations were performed in several areas using standardized mean differences (d) effect-size estimate and homogeneity testing. Three critical issues have been the focus of the present analysis: the early intervention phase, treatment procedures and their additive properties and the transitional period between early and late effects of treatment. Results: The main findings while integrating the results in a new way were that intervention studies with one single session showed a small but robust homogeneous effect size, whereas studies of interventions with several sessions were heterogeneous with large and small effect sizes among the included studies. Similar effect sizes were found in alcohol, opioid and cocaine treatment studies. Agonist treatment yielded the highest effect sizes. Some evidence was found for a possible additive effect for cognitive behaviour therapy and naltrexone as well as for aversive treatment (disulfiram) and psychosocial treatment in alcohol dependence. So far studies on the transition period between short- and long-term outcome are few and inconclusive. Conclusions: There is a prospect of improving addiction treatment, and the following areas are suggested by meta-analysis for future research: (a) to examine in more detail the process between the first and second session of intervention; (b) to randomize simultaneously for independent categories of psychosocial and psychopharmacological treatment; and (c) to intensify studies on the transitional period between short- and long-term outcome.

Bootzin RR; Stevens SJ. Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review 25(5): 629-644, 2005. (79 refs.)

Adolescence is a time of change that can be both exciting and stressful. In this review, we focus on the central role that disturbed sleep and daytime sleepiness occupies in interactions involving substance abuse and negative health, social, and emotional outcomes. As a means of improving sleep and lowering risk for recidivism of substance abuse, we developed and implemented a six-session group treatment to treat sleep disturbances in adolescents who have received treatment for substance abuse. The components of the treatment are stimulus control instructions, use of bright light to regularize sleep, sleep hygiene education, cognitive therapy, and Mindfulness-Based Stress Reduction. Preliminary evidence indicates that participants who completed four or more sessions in the treatment program showed improved sleep and that improving sleep may lead to a reduction in substance abuse problems at the 12-month follow-up.

Bricker JB; Russo J; Stein MB; Sherbourne C; Craske M; Schraufnagel TJ et al. Does occasional cannabis use impact anxiety and depression treatment outcomes? Results from a randomized effectiveness trial. Depression and Anxiety 24(6): 392-398, 2007. (32 refs.)

This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-bebavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (P <. 01) evidence of an interaction between treatment group (CCAP vs. usual care) and cannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users.

Budney AJ; Moore BA; Rocha HL; Higgins ST. Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence. Journal of Consulting and Clinical Psychology 74(2): 307-316, 2006. (31 refs.)

Ninety cannabis-dependent adults seeking treatment were randomly assigned to receive cognitive-behavioral therapy, abstinence-based voucher incentives, or their combination. Treatment duration was 14 weeks, and outcomes were assessed for 12 months posttreatment. Findings suggest that (a) abstinence-based vouchers were effective for engendering extended periods of continuous marijuana abstinence during treatment, (b) cognitive-behavioral therapy did not add to this during-treatment effect, and (c) cognitive-behavioral therapy enhanced the posttreatment maintenance of the initial positive effect of vouchers on abstinence. This study extends the literature on cannabis dependence, indicating that a program of abstinence-based vouchers is a potent treatment option. Discussion focuses on the strengths of each intervention, the clinical significance of the findings, and the need to continue efforts toward development of effective interventions.

Burleson JA; Kaminer Y. Aftercare for adolescent alcohol use disorder: Feasibility and acceptability of a phone intervention. American Journal on Addictions 16(3): 202-205, 2007. (23 refs.)

A lack of continuity of care for adolescents with alcohol and other substance use disorders (AOSUD) is common. The objectives of this brief report are to present the rationale for the use of manualized, individual brief therapeutic phone contacts (IBTPC) integrating motivational interviewing and cognitive behavioral therapies for aftercare in youth with AOSUD; and report the results and discuss the implications of a study on the feasibility and acceptability of IBTPC in youths with AOSUD. Four therapists and forty-three adolescents who completed IBTPC responded to a questionnaire concerning the acceptability, feasibility, and confidentiality of the IBTPC. In general, both subjects and therapists were positively consistent in their endorsement of the common items. In conclusion, aftercare for adolescents with AOSUD utilizing a brief phone intervention is perceived as feasible and acceptable.

Burleson JA; Kaminer Y. Self-efficacy as a predictor of treatment outcome in adolescent substance use disorders. Addictive Behaviors 30(9): 1751-1764, 2005. (41 refs.)

Youth substance abuse relapse prevention was examined as a function of patients' situational self-efficacy (SE), their confidence to abstain from substance use in high-risk situations. Art increase in SE has been shown to be enhanced by cognitive behavioral therapy (CBT) in adults. Eighty-eight adolescent substance abusers were randomly assigned to either CBT or psycho-education (PET) group therapy. Substance use and SE were assessed at end of treatment, 3- and 9-months after the end of planned treatment. Increased SE predicted subsequent abstinence independently from drug urinalysis and treatment condition only during treatment, while previous substance use predicted subsequent self-efficacy. CBT was not differentially effective than PET in promoting SE. It is recommended that potential mediators and moderators of SE in the treatment of adolescent substance abuse should be further explored.

Callaghan R; Taylor L; Victor JC; Lentz T. A case-matched comparison of readmission patterns between primary methamphetamine-using and primary cocaine-using adolescents engaged in inpatient substance-abuse treatment. Addictive Behaviors 32(12): 3101-3106, 2007. (8 refs.)

Objective: In the United States and Canada, elevated patterns of methamphetamine-related treatment admissions among youth have triggered questions about appropriate substance-abuse treatment strategies for methamphetamine-using adolescents. This study aimed to provide a comparative examination of the readmission patterns of primary methamphetamine-using and primary cocaine-using adolescents to a cognitive behavioral therapy (CBT)-based alcohol-and-drug inpatient treatment program. Methods: The current study employed a 5-year medical-chart review of all consecutive admissions to an inpatient, hospital-based substance-abuse treatment program for adolescents in northern British Columbia, Canada. After using a propensity-score-matching approach to construct a case-matched sample (n = 202) of primary methamphetamine-using and primary cocaine-using adolescents, we employed a Kaplan-Meier survival analysis technique to test group differences in time-to-readmission. Results: The findings demonstrated that the methamphetamine group did not have a more severe time-to-readmission profile. Conclusions: General CBT-based treatment-as-usual approaches appear to produce similar long-term readmission outcomes for these two groups of treatment-seeking adolescents.

Carrao JL; Moreira LB; Fuchs FD. The efficacy of the combination of sertraline with buspirone for smoking cessation - A randomized clinical trial in nondepressed smokers. European Archives of Psychiatry and Clinical Neuroscience 257(7): 383-388, 2007. (37 refs.)

In a double-blind placebo-controlled trial, we evaluated the efficacy of the combination of sertraline and buspirone plus cognitive-behavioral treatment to promote tobacco abstinence in individuals referred to a chemical dependency clinic. Ninety eight individuals 18-65 years of age were randomized to placebo or sertraline 25 mg/day for 2 days, followed by 50 mg from day 3 to 90, and buspirone 5 mg three times a day for 7 days, and 10 mg from day 8 to 90. The rate of continuous abstinence at the 26th week of follow-up, informed by the patient, was 43.5% in the active treatment group and 17.3% in the control group (p = 0.01). The odds ratio for continuous abstinence for the intervention group was 4.74 (95% CI 1.50-14.55) (adjusted for smoker households and number of cognitive sessions). Nicotine withdrawal symptoms were common in both groups (98.7% vs. 95.5% p = 0.37). The combination of sertraline and buspirone with cognitive-behavioral therapy was more effective than placebo and, cognitive-behavioral therapy to promote smoking cessation.

Carroll KM; Easton CJ; Nich C; Hunkele KA; Neavins TM; Sinha R et al. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology 74(5): 955-966, 2006. (70 refs.)

Marijuana-dependent young adults (N = 136), all referred by the criminal justice system, were randomized to I of 4 treatment conditions: a motivational/skills-building intervention (motivational enhancement therapy/cognitive-behavioral therapy; MET/CBT) plus incentives contingent on session attendance or submission of marijuana-free urine specimens (contingency management; CM), MET/CBT without CM, individual drug counseling (DC) plus CM, and DC without CM. There was a significant main effect of CM on treatment retention and marijuana-free urine specimens. Moreover, the combination of MET/CBT plus CM was significantly more effective than MET/CBT without CM or DC plus CM, which were in turn more effective than DC without CM for treatment attendance and percentage of marijuana-free urine specimens. Participants assigned to MET/CBT continued to reduce the frequency of their marijuana use through a 6-month follow-up.

Carroll KM; Nich C; Ball SA. Practice makes progress? Homework assignments and outcome in treatment of cocaine dependence. Journal of Consulting and Clinical Psychology 73(4): 749-755, 2005. (18 refs.)

The relationship between treatment outcome and the extent to which participants completed homework assignments was evaluated among 60 cocaine-dependent individuals assigned to cognitive-behavioral therapy (CBT). Homework was assigned in 72% of all sessions and initiated by participants in 48% of the sessions in which it was assigned. Completion of homework was unrelated to participants' baseline characteristics and several indicators of treatment compliance. Participants who completed more homework assignments demonstrated significantly greater increases in the quantity and quality of their coping skills and used significantly less cocaine during treatment and through a 1-year follow-up. These data suggest that the extent to which participants are willing to complete extrasession assignments may be an important mediator of response to CBT.

Cavallo DA; Cooney JL; Duhig AM; Smith AE; Liss TB; McFetridge AK et al. Combining cognitive behavioral therapy with contingency management for smoking cessation in adolescent smokers: A preliminary comparison of two different CBT formats. American Journal on Addictions 16(6): 468-474, 2007. (29 refs.)

This pilot study evaluated the optimal format of cognitive behavioral therapy (CBT) to combine with contingency management (CM) in a four-week, high school-based smoking cessation program. Thirty-four adolescent smokers received a standard weekly version of CBT or a frequent brief behavioral intervention. Results indicate a trend toward a higher seven-day point prevalence end-of-treatment abstinence rate and percent days abstinent during treatment in the CBT condition. In addition, significantly more participants in the CBT group completed treatment. These preliminary results suggest that when combined with CM, the standard weekly format of CBT is more acceptable to adolescent smokers.

Chatkin JM; Abreu CM; Blanco DC; Tonietto R; Scaglia N; Wagner MB et al. No gender difference in effectiveness of smoking cessation treatment in a Brazilian real-life setting. International Journal of Tuberculosis and Lung Disease 10(5): 499-503, 2006. (29 refs.)

BACKGROUND: The clinical effectiveness of pharmacotherapy for smoking cessation in real-life settings has yet to be evaluated. OBJECTIVES: To assess the effectiveness of bupropion in general clinical practice for smoking cessation and to identify predictors of failure. METHODS: In an open, non-randomised study, smokers were recruited at the Smoking Cessation Clinics, Hospital Sao Lucas, Porto Alegre, Brazil. Subjects participated in a motivational group meeting, completed a standardised questionnaire and Fagerstrom test, and had their vital signs and exhaled CO registered. All participants received a prescription of bupropion and the same cognitive behaviour therapy. They attended eight weekly individual sessions, then monthly until the sixth month and a final session at month 12. The primary outcome measure was the rate of abstinence at 12 months. The predictor factors studied were sex, age, educational level, nicotine dependence, previous attempts and comorbidities. RESULTS: Among 253 smokers (62.5% females), abstinence rates at 6 months were 20.8% for males and 22.7% for females. The success rates dropped to 13.9% and 14.3% for males and females, respectively. CONCLUSIONS: Cognitive therapy plus bupropion for smoking cessation in real-life clinics in Brazil were similar to the efficacy found in clinical trials. No significant gender differences in success rates were found.

Clark MM; Hays JT; Vickers KS; Patten CA; Croghan IT; Berg E et al. Body image treatment for weight concerned smokers: A pilot study. (rapid communication). Addictive Behaviors 30(6): 1236-1240, 2005. (10 refs.)

In this pilot project, 41 female weight-concerned smokers were randomly assigned to receive either 12 group sessions of cognitive behavioral therapy for body image concerns or 12 group sessions for weight management. All subjects received open-label bupropion SR, 300 mg daily, exercise instruction, and weekly behavioral counseling for tobacco cessation. At week 12, 7(35%) of the body image participants had 7-day point prevalence smoking abstinence, compared to 5(24%) of the participants in the weight management group (p=0.505).

Cohen LR; Hien DA. Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services 57(1): 100-106, 2006. (31 refs.)

Objective: This study assessed the effect of cognitive-behavioral therapy on a range of problems associated with complex trauma in a sample of women with comorbid substance use disorders and posttraumatic stress disorder ( PTSD). Methods: A total of 107 women with current or subthreshold PTSD and a current substance use disorder from an urban, low-income area were recruited from both community and clinical populations. Participants were recruited between 1997 and 2000. A quasi-experimental design was used, and participants who received cognitive-behavioral therapy (N=75) were compared with those in a control group who received no active study treatment (N=32). All participants were given the same list of community treatment resources and told that they could pursue services while participating in the study if they wished. Results: At the end of treatment (three months post-baseline), compared with participants in the control group, those in the active treatment group showed significant reductions in symptoms of PTSD and alcohol use disorders, with a trend toward reductions in symptoms of drug use disorders. No significant differences were found between the groups on depression, dissociation, and social and sexual functioning outcomes. Conclusions: These findings underscore the challenge and necessity of addressing the unique and wide-ranging needs of women with substance use disorder who have been exposed to early and multiple interpersonal traumas.

Davidson D; Gulliver SB; Longabaugh R; Wirtz PW; Swift R. Building better cognitive-behavioral therapy: Is broad-spectrum treatment more effective than motivational-enhancement therapy for alcohol-dependent patients treated with naltrexone? Journal of Studies on Alcohol and Drugs 68(2): 238-247, 2007. (33 refs.)

Objective: The current study investigated the treatment effectiveness, during treatment, of a second-generation cognitive-behavioral therapy for alcoholism-broad-spectrum treatment (BST)-compared with motivational -enhancement therapy (MET), when both were offered in conjunction with a therapeutic dose of naltrexone (Revia). Method: One hundred forty-nine alcohol-dependent patients completed a 3-month randomized, controlled trial of BST and naltrexone versus MET and naltrexone. Results: Patients receiving BST had a significantly higher percentage of days abstinent than patients receiving MET. The superior effect of BST is particularly strong in interaction with support for drinking, suggesting that the advantage of BST is worth the additional cost for patients whose psychosocial networks are supportive of continued drinking. This effect remains significant when controlling for pretreatment percentage of days abstinent. Conclusions: In aggregate, these findings suggest that it is either the combination of naltrexone and BST or the unique properties of BST that account for BST's superiority to MET and naltrexone. The results of this initial phase of the trial suggest that a second-generation cognitive-behavioral therapy such as BST may have a meaningful clinical advantage over brief interventions such as MET, at least when combined with naltrexone.

Dowling N; Smith D; Thomas T. A comparison of individual and group cognitive-behavioural treatment for female pathological gambling. Behaviour Research and Therapy 45(9): 2192-2202, 2007. (15 refs.)

The current study aimed to determine the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered in individual and group format. Fifty-six female pathological gamblers with electronic gaming machine gambling problems were randomly assigned to the control (waiting list) group or one of the treatment groups (individual or group treatment). Treatment comprised a 12-session program including financial limit setting, alternative activity planning, cognitive correction, problem solving, communication training, relapse prevention, and imaginal desensitisation. Treatment outcome was evaluated with conceptually related measures within the areas of gambling behaviour and psychological functioning. While individual and group treatment formats generally produced comparable outcomes in terms of gambling behaviour and psychological functioning, group treatment failed to produce superior outcomes to the control group in relation to several measures of psychological functioning. Moreover, by the completion of the six-month follow-up, 92% of the gamblers allocated to individual treatment compared with 60% allocated to group treatment no longer satisfied the diagnostic criteria for pathological gambling. These findings suggest that some caution should be employed when delivering cognitive-behavioural treatment in a group format until further research is conducted to establish its efficacy.

Drummond C; Kouimtsidis C; Reynolds M; Russell I; Godfrey C; McCusker M; UKCBTMM Project Group. The effectiveness and cost effectiveness of cognitive behaivor therapy for opiate misusers in methadone maintenance treatment. A mulicentre, randomised, controlled trial. UKCBTMM Study: United Kingdom Cognitive Behaviour Therapy Study in Methadone Maintenance Treatment. Drugs: Education, Prevention, and Policy 12(Supplement 1): 69-76, 2005. (0 refs.)

A major study was conducted to assess the effectiveness of cognitive behavioural therapy as an adjunct to accompany methadone-maintenance. The research design is described, inclusion and exclusion criteria, and the nature of the intervention (50 minute weekly sessions for up to 24 sessions over six months.) Outcome was compared between methadone and counseling to methadone alone. Among the findings was that outcome was not improved for the methadone plus therapy group. There were no differences in cost effectiveness between these conditions. The limitations to this research and implications for practice are described.

Dziegielewski SF; Van Bibber CA. Cannabis. IN: Dziegielewski SF, ed. Prescription drugs of abuse: Sedatives, hypnotics, and painkillers. Chicago: Lyceum Books, 2005. pp. 191-207. (34 refs.)

Cannabis, commonly termed marijuana, is the most widely used illicit drug. The chapter begins with a overview of the history and attitudes toward marijuana, and current use patterns. This is followed by a case study which is used to illustrate interventions, sample treatment plans and best practices. Cognitive-behavioral treatments are consided the most promising.

Easton CJ; Mandel D; Babuscio T; Rounsaville BJ; Carroll KM. Differences in treatment outcome between male alcohol dependent offenders of domestic violence with and without positive drug screens. Addictive Behaviors 32(10): 2151-2163, 2007. (35 refs.)

Men who are violent toward their partners tend to have a dual problem with alcohol and drug use, yet little is known about differences between men with single rather than dual problems. This study was one of the first to evaluate differences between alcohol dependent men who were arrested for Intimate Partner Violence (IPV) with and without concurrent illicit drug use. Seventy-eight participants were randomly assigned to manual-guided group behavioral therapies (Cognitive Behavioral Therapy or Twelve Step Facilitation) and assessed across 12 weeks of treatment. Despite denying drug use at baseline, thirty-two clients (43%) tested positive for illicit drug use (cocaine and marijuana) during the 12 weeks of treatment. The study specifically addressed whether there were differences between clients using alcohol only versus individuals using both alcohol + drugs in terms of 1) baseline characteristics; 2) treatment compliance (e.g., attendance and substance use during treatment; and 3) treatment outcomes (alcohol, drug use, anger management, and aggression at the completion of treatment). The results showed that there were comparatively few differences between the alcohol versus the alcohol + drug using groups at baseline. Regarding treatment compliance and retention, alcohol + drug using participants attended significantly fewer sessions, had significantly fewer percent days abstinence from alcohol use, significantly more total days of positive breathalyzer results. Regarding treatment outcomes across anger management and aggression scores, the alcohol + drug using participants had significantly more impairments in anger management styles from pre- to post-treatment. However, there were no differences between the groups across verbal or physical aggression. Both groups improved in their verbal aggression from pre- to post-treatment. The findings suggest that alcohol dependent men who continue to use illicit drugs may require additional interventions to effectively control their drug use and, their anger management styles.

Easton CJ; Weinberger AH; George TP. Age of onset of smoking among alcohol dependent men attending substance abuse treatment after a domestic violence arrest. Addictive Behaviors 32(10): 2020-2031, 2007. (46 refs.)

This study examined differences between alcohol dependent offenders of intimate partner violence (IPV) with early initiation of cigarette smoking versus alcohol dependent offenders of IPV with later initiation of cigarette smoking. Seventy-eight alcohol dependent men who were arrested for domestic and referred to substance abuse treatment were randomly assigned to manual-guided behavioral therapies (Cognitive Behavioral Therapy or Twelve Step Facilitation). Sixty-two clients reported smoking cigarettes (85%) while 52 reported smoking cigarettes (71%) on a daily basis. Early initiation of smoking was defined as smoking cigarettes before the age of 16 years of age, while later initiation of smoking was defined as smoking cigarettes from 16.5 years and older. Regarding baseline characteristics, participants assigned to the early initiation of smoking condition had significantly more domestic violence arrests and significantly higher anger expression scores at baseline compared to the late smoking initiation group. Despite more severity of substance abuse, legal and violence characteristics at the baseline assessment in the early initiation group, both smoking initiation groups responded equally as well across 12 weeks of manualized behavioral treatments. The implications of these findings are discussed.

Edelman S; Remond L. Group cognitive behavior therapy program with troubled adolescents: A learning experience. Child & Family Behavior Therapy 27(3): 47-59, 2005. (20 refs.)

Group CBT programs are widely used for assisting teenagers with anxiety, depression and other psychological problems. The majority of reported programs have targeted school or clinical populations, however, few have specifically targeted adolescents from highly troubled and disadvantaged backgrounds. This paper describes a group CBT program that was developed for teenagers who have not responded well to the formal structures of school and traditional models of classroorn management. Problems such as low levels of motivation, poor attention span, learning difficulties, poor impulse control, substance abuse, and other mental health problems are common within this population. A number of challenges arose in running the program and several modifications were made in order to make it more relevant to participants. These changes resulted in more rapid engagement with the program, improved cooperation within the group, fewer interruptions, and improved rapport. The clinical outcomes associated with the program could not be measured due to difficulties with completing administering self-report questionnaires.

Esposito-Smythers C; Spirito A; Uth R; LaChance H. Cognitive behavioral treatment for suicidal alcohol abusing adolescents: Development and pilot testing. American Journal on Addictions 15(Supplement 1): 126-130, 2006. (21 refs.)

The purpose of this study was to pilot a cognitive behavioral treatment protocol for adolescents with co-occurring alcohol use disorder and suicidality, examine its association with symptomatic improvement, and determine its feasibility and acceptability. Treatment consisted of a 6 month acute treatment phase, 3 month maintenance phase, and a 3 month booster phase, as well as case management services. Participants were also permitted to receive concurrent pharmacotherapy. Five of six families completed the protocol. Measures of alcohol use and suicidality were collected at intake, end of acute treatment, and post-treatment. Decreases in alcohol use and suicidal ideation were reported for all participants. Two of the five participants, both with a prior history of suicide attempts, re-attempted during the course of the protocol. Both were maintained in the study and improved over the subsequent portion of the treatment. A high retention rate, strong therapeutic alliance ratings, and low perceived treatment obstacles provide support for the feasibility and acceptability of this intervention. Preliminary results suggest that integrated outpatient cognitive behavioral treatment for alcohol abusing suicidal adolescents is feasible, acceptable, and associated with symptomatic improvement.

Feeney GFX; Connor JP; Young RM; Tucker J; McPherson A. Improvement in measures of psychological distress amongst amphetamine misusers treated with brief cognitive-behavioural therapy (CBT). Addictive Behaviors 31(10): 1833-1843, 2006. (25 refs.)

This trial of cognitive-behavioural therapy (CBT) based amphetamine abstinence program (n = 507) focused on refusal self-efficacy, improved coping, improved problem solving and planning for relapse prevention. Measures included the Severity of Dependence Scale (SDS), the General Health Questionnaire-28 (GHQ-28) and Amphetamine Refusal Self-Efficacy. Psychiatric case identification (caseness) across the four GHQ-28 sub-scales was compared with Australian normative data. Almost 90% were amphetamine-dependent (SDS 8.15 +/- 3.17). Pretreatment, all GHQ-28 sub-scale measures were below reported Australian population values. Caseness was substantially higher than Australian normative values {Somatic Symptoms (52.3%), Anxiety (68%), Social Dysfunction (46.5%) and Depression (33.7%). One hundred and sixty-eight subjects (33%) completed and reported program abstinence. Program completers reported improvement across all GHQ-28 sub-scales Somatic Symptoms (p < 0.001), Anxiety (p < 0.001), Social Dysfunction (p < 0.001) and Depression (p < 0.001)}. They also reported improvement in amphetamine refusal self-efficacy (p < 0.001). Improvement remained significant following intention-to-treat analyses, imputing baseline data for subjects that withdrew from the program. The GHQ-28 sub-scales, Amphetamine Refusal Self-Efficacy Questionnaire and the SDS successfully predicted treatment compliance through a discriminant analysis function (p <.001).

Feeney GFX; Connor JP; Young RM; Tucker J; McPherson A. Is acamprosate use in alcohol dependence treatment reflected in improved subjective health status outcomes beyond cognitive behavioural therapy alone? Journal of Addictive Diseases 25(4): 49-58, 2006. (30 refs.)

Objective. To examine whether the addition of acamprosate to Cognitive Behavioural Therapy (CBT) outpatient alcohol dependence treatment impacted on subjective health status. Method. Among 268 patients consecutively treated for alcohol dependence, 149 chose CBT alone. A matched design was used. From a possible pool of 119 Acamprosate + CBT and 149 CBT-only patients, 86 Acamprosate + CBT subjects were individually matched with 86 CBT-only patients on parameters of gender, age, prior detoxification and alcohol dependence severity. Health Status (SF-36) and Psychological Well-Being (GHQ-28) was assessed pre- and post-treatment. Results. Pre-treatment, both self-reported health status and psychological well-being was markedly below normative (community) ranges. Program completers significantly improved across both measures over 12 weeks of treatment and some health domains approximated community levels. No treatment group differences were observed. Conclusions. Participants who completed the CBT-based treatment showed significant improvement in self-reported health status. The use of acamprosate did not register additional improvement on either SF-36 or GHQ-28, beyond CBT alone.

Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. (Chapter refs.)

This is the third edition of a major reference work in the field of addiction medicine, which was created by the founders of the American Academy of Addiction Psychiatry (AAAP) It is organized into five major sections, with a total of 28 chapters and 51 contributors. This volume provides historical background, diagnostic process and assessment, diagnostic tools, substance specific discussions of the major drug classes, covers the full range of treatment approaches and how these can be adapted to the needs and characteristics of special populations. It also discusses other "behavioral" addictions such as gambling disorders. Section I deals with the foundations of addiction medicine, the neurobiology of substance dependence and the historical and social context of psychoactive substance use disorders. Section II is directed to assessment, both psychological evaluation in adolescents and adults, and laboratory testing. Section III deals with major drug classes: alcohol, nicotine, opiates, marijuana, hallucinogens, and club drugs, cocaine and stimulants, and sedative/hypnotics and benzodiazepines. Section IV considers special populations and special issues: comorbidity, polysubstance abuse; women; the elderly; the workplace; HIV/AIDS; pain; pathological gambling and other "behavioral" disorders. The final section is directed to treatment: individual psychodynamic psychotherapy; cognitive therapy, group therapy; self-help; family-therapy; adolescent treatment; and treatment matching.

Galanter M, ed. Recent Developments in Alcoholism, Volume 17. Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic/Plenum Press, 2005. (Chapter refs.)

The edited volume in the series "Recent Developments in Alcoholism" addresses teen drinking -- epidemiology, neurobiology, behavioral phenomena, diagnostic and assessment issues, prevention and treatment data -- in a developmental context. It is organized into four sections and includes 17 chapters and 50 contributors. In the first section on epidemiology, chapters deal with the initiation and course of alcohol use, those at risk for alcohol problems, as well as both acute and long-term problems. Section II on neurobiology considers the age-related effects, as well effects on memory, and phenomenon related to the fact that the adolescent brain is not fully matured. Section III on prevention contains chapters dealing with programs for specific populations, such as college students, and high risk groups, as well as an examination of policies to reduce underage drinking. In respect to treatment, attention is directed to co-occurring alcohol, drug and psychiatric disorders, cognitive-behavioral treatments, family therapy, and elements involved in assessment.

Glasner-Edwards S; Tate SR; McQuaid JR; Cummins K; Granholm E; Brown SA. Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression. Journal of Studies on Alcohol and Drugs 68(5): 663-672, 2007. (49 refs.)

Objective: In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF). Method: Veterans (N = 148) were given standard pharmacotherapy for depression and were randomly assigned to receive 24 weeks of either TSF or ICBT. Process measures were selected to quantify (1) changes in self-efficacy in ICBT, (2) changes in ability to terminate negative affect in ICBT, (3) twelve-step affiliation (TSA) in TSF, and (4) changes in social support in both conditions. Measures of depression and substance use were administered to all participants before treatment, during treatment, and at the end of treatment. Results: Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change. Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA. Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment. Hypothesized changes in social support were not supported. Conclusions: Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers. In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.

Glassmire DM; Welsh RK; Clevenger JK. The development of a substance abuse treatment program for forensic patients with cognitive impairment. Journal of Addictions & Offender Counseling 27(2): 66-81, 2007. (64 refs.)

The Substance Abuse and Mental Illness (SAMI) program combines cognitive rehabilitation and dual-diagnosis substance abuse treatment within a stages of change context. This article describes the development, implementation, and preliminary outcome analysis of the SAMI program in a forensic hospital.

Glover M. Analysing smoking using Te Whare Tapa Wha. New Zealand Journal of Psychology 34(1): 13-19, 2005. (25 refs.)

In a doctorate study on Maori smoking cessation behaviour, Te Whare Tapa Wha, a contemporary Maori paradigm was used as the theoretical framework for analyzing smoking behaviour. One hundred and thirty Maori smokers aged 16-62, who were intending to quit were interviewed prior to their quit attempt and on average four months later. Physical aspects of smoking behaviour, such as, smoking history variables and number of cigarettes smoked per day were grouped under te taha tinana. Variables, such as, participants' beliefs about their reasons for smoking, motivation and intention to quit were grouped under te taha hinengaro. Social and familial factors that influenced participants' smoking are discussed under te taha whanau and data pertaining to actions or beliefs about the effects on and the role of wairua are discussed under te taha wairua. The results show how the application of Te Whare Tapa Wha to the problem of smoking supports the need for holistic approaches to intervention. Smoking cessation interventions, for instance, need to combine treatment of nicotine dependency with cognitive behavioural therapy, whilst targeting the whole whanau. Attending to te taha wairua should improve effectiveness for Maori. Public health policies and programmes, such as a strong Smokefree Environments Act and frequent exposure to smokefree media campaigns, help create a supportive environment for change.

Grassi MC; Cioce AM; Giudici FD; Antonilli L; Nencini P. Short-term efficacy of Disulfiram or Naltrexone in reducing positive urinalysis for both cocaine and cocaethylene in cocaine abusers: A pilot study. Pharmacological Research 55(2): 117-121, 2007. (38 refs.)

Cocaine abusers frequently report taking the drug in association with alcohol. This combined intake leads to the synthesis of cocaethylene, an active metabolite with effects similar to those of cocaine, but more prolonged. Since pharmacological effects of cocaethylene may partially account for the habit of cocaine abusers to take the drug in combination with ethanol, a main therapeutic goal in these patients should be making body fluids negative for cocaethylene. This randomized controlled open study conducted on 12 subjects co-abusers of cocaine and alcohol, evaluates the efficacy of a 12-week pharmacological treatment with Disulfiram (DIS) 400 mg daily or Naltrexone (NTX) 50 mg daily associated with Cognitive Behaviour Therapy (CBT), as compared to CBT alone, in terms of: (i) stay in treatment; (ii) drug-free urinalyses for cocaine and cocaethylene; (iii) reduction of alcohol and cocaine craving. Data presented in this study are restricted to the first 4 weeks of treatment when all the enrolled subjects were still available for examination. In fact, of the 12 subjects enrolled in the study only 4 (33%) completed the 12-week treatment. Of these, three were in the CBT group and one in the NTX/CBT group. Results show that CBT treated subjects remained in treatment longer than those assigned to either DIS/CBT or NTX/CBT therapies. However, during the first 4 weeks of treatment, CBT-group urine tested positive almost always for both cocaine and cocaethylene. In contrast, both DIS/CBT and NTX/CBT treatments were associated to a statistically significant reduction, of positive urinalysis for both cocaine and cocaethylene, with respect to CBT alone. Moreover, across the first 4 weeks of treatment DIS/CBT and NTX/CBT treated subjects maintained lower scores at Visual Analogue Scales (VAS) for both cocaine and alcohol craving than subjects receiving CBT alone. This pilot study suggests that the transient efficacy of pharmacological treatments in maintaining subjects drug free, does not add to the capability of CBT to retain them in treatment.

Gulliver SB; Longabaugh R; Davidson D; Swift R. The development of a broad spectrum treatment for patients with alcohol dependence in early recovery. Cognitive and Behavioral Practice 12(1): 53-63, 2005. (44 refs.)

Estimates of the prevalence of alcohol dependence among Americans approach 14% (Read, Kohler, & Stevenson, 2001). Alcohol dependence was once considered among the most recalcitrant of problem behaviors, with only 20% to 30% attaining sustained abstinence (Hunt Barnett & Branch, 1971). Although current definitions of treatment success now consider lapses and recycling (e.g., DiClemente, 2003), sustained abstinence remains the gold standard and is achieved in up to 60% of people in efficacy trials of current psychosocial treatments (e.g., Project MATCH). This article describes our efforts to develop the next-generation CBT treatment manuals for patients in early abstinence from alcohol, Broad Spectrum Treatment (BST). BST attempts to simultaneously address two seemingly incompatible treatment research goals. First, BST is a flexible but manual-guided treatment that can be standardized and used in the field with the broad spectrum of alcohol abusers. Second, BST seeks to maximize treatment effectiveness by tailoring the specific treatment package to the individual patient's needs and capacities. Use of explicitly defined a priori decision trees is the vehicle through which these goals can be accomplished. This article describes the manual in its current form, and discusses the manner in which we are presently testing the efficacy of the manual as it stands.

Harwood TM; Beutler LE; Castillo S; Karno M. Common and specific effects of couples treatment for alcoholism: A test of the generic model of psychotherapy. Psychology and Psychotherapy. Theory, Research and Practice 79(Part 3): 365-384, 2006. (38 refs.)

The generic model of psychotherapy (Orlinsky & Howard, 1987) eschews the view that inputs, processes or outputs associated with treatment exert linear and independent effects on outcomes. Variables within these three clusters must be viewed both within the context of time and through their interactions with other variables within a class. This study illustrates the use of this model by identifying common (comprising both traditional relationship factors and shared therapy ingredients) and specific factors in cognitive-behavioural (CB) and family systems (FS) treatments for alcoholic couples and tracking their contributions over two treatment phases - the acute phase, and the follow-up phase. While four process variables (therapy type, intensity of treatment, common elements and FS-specific procedures) contributed to outcomes during the active treatment phase, these variables became more interactive during follow-up. Indeed, high levels of both specific interventions of both treatments were negatively associated with benefit, if common factors were also frequently used during the acute phase. The best effects were obtained when common and specific interventions were counterbalanced, one being frequently used and the other being infrequently used. Implications for future alcohol treatment and recommendations for research on common and specific factors are discussed.

Hides L; Elkins K; Catania LS; Mathias S; Kay-Lambkin F; Lubman DI. Feasibility and outcomes of an innovative cognitive-behavioural skill training programme for co-occurring disorders in the youth alcohol and other drug (AOD) sector. Drug and Alcohol Review 26(5): 517-523, 2007. (30 refs.)

There are limited treatment options available for young drug users with comorbid mental health problems who present to alcohol and other drug (AOD) services within Australia. While there is some evidence for the use of cognitive-behaviour therapy (CBT) in the treatment of co-occurring disorders, CBT is rarely used to address comorbidity in the AOD sector. This paper describes the development, implementation and evaluation of a brief cognitive-behavioural skills (BCBS) training programme for addressing comorbidity within two youth A OD services in Australia. Ten youth A OD workers completed a 2-day training programme in the BCBS. Training was evaluated using measures of trainees' cognitive-behavioural knowledge, attitudes towards mental health interventions and level of skills and confidence in each of the BCBS pre- and 6 months post-training. The BCBS training had a positive impact on the knowledge, skills and confidence of trainees and was perceived to be highly relevant and appropriate. These findings provide preliminary support for the feasibility and effectiveness of the BCBS training programme for workers within the youth AOD sector.

Hogue A; Dauber S; Stambaugh LF; Cecero JJ; Liddle HA. Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology 74(1): 121-129, 2006. (50 refs.)

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations.

Hoppes K. The application of mindfulness-based cognitive interventions in the treatment of co-occurring addictive and mood disorders. (review). CNS Spectrums 11(11): 829+, 2006. (61 refs.)

This article reviews the theory, clinical application, and empirical findings on mindfulness-based cognitive therapy (MBCT) for mental health and addictive disorders. Expanding upon the research demonstrating the efficacy of cognitive-behavioral therapy (CBT) for addiction, this article develops and explores the rationale for combining mindfulness-based interventions with evidence-based CBTs in treating addictive disorders, with an emphasis on substance use disorders with co-occurring mood disorders. This article proposes that deficits in affect regulation-related to the behavioral and emotional effects of neurobiological changes that occur with long-term substance abuse-pose a unique set of challenges in early recovery. Prolonged use of addictive substances impairs the brain pathways that mediate certain affect regulation functions. These functions involve attention and inhibitory control, the saliency of and response to addictive versus natural reward stimuli, and the ability to detach or maintain perspective in response to strong emotional states. In treating this affective dysregulation, which can contribute to the vulnerability to relapse in the early stages-of recovery, the affect-regulation-specific focus of MBCT adds a valuable element to augment CBT for addiction. Summarizing magnetic resonance imaging and positron emission tomography findings on the effects of MBCT and the neurobiology of drug addiction, this article outlines directions for further research on potential benefits of MBCT for the recovering individual. Finally, this article describes a structured protocol, developed at the Mount Sinai School of Medicine in New York City, which combines CBT with mindfulness-based intervention, for the treatment of affect-regulation issues specific to co-occurring addictive and mood disorders.

Johnson KO; Berglund M. Comparison between a cognitive behavioural alcohol programme and post-mailed minimal intervention in high-risk drinking university freshmen: Results from a randomized controlled trial. Alcohol and Alcoholism 41(2): 174-180, 2006. (39 refs.)

Aim: Examine the effect of a 10 h intervention programme compared with post-mailed minimal intervention (PMMI) given to high-risk alcohol-drinking university freshmen in a random design. Method: In total 693 freshmen at the Lund Institute of Technology, Lund University, Sweden were included in the study. A cognitive behavioural alcohol program (CBAP) or PMMI was given to high-risk drinking freshmen (n = 177) in a randomized design. A 10-item screening instrument, Alcohol Use Disorder Identification Test (AUDIT), was used before and 1 year after the intervention programmes were given. Results: There were no significant differences between the CBAP and the PMMI groups. Both groups declined their AUDIT scores with -1.7 [CI 95% -2.6, -0.7] and -2.7 [CI 95% -3.6, -1.7], respectively which could be explained by effects of regression to the mean. Conclusion: No significant differences between the groups were found.

Johnson JE; Finney JW; Moos RH. End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: Do they differ and do they predict 1-year outcomes? Journal of Substance Abuse Treatment 31(1): 41-50, 2006. (21 refs.)

This study examined changes in treatment-related proximal outcomes from intake to follow-up, associations between continuing care and maintenance of proximal outcome gains, correlations between specific proximal outcomes and substance use outcomes, and potential mediators of treatment effects for 12-step versus cognitive-behavioral (CB) substance use disorder (SUD) treatment. The participants were 1,873 male veterans seeking SUD treatment at five CB-oriented and five 12-step-oriented VA inpatient/residential SUD programs. Patterns of change in proximal outcomes were similar across the two program types. After discharge, attendance at 12-step groups, but not outpatient treatment, was associated with greater maintenance on most proximal outcomes. Only a few proximal outcomes at discharge were associated with 1-year substance use; most 1-year proximal outcomes were associated with 1-year substance use. Having a sponsor, reading 12-step materials, attending 12-step meetings, and having an abstinence goal appeared to mediate the greater effects of 12-step programs (relative to CB programs) on abstinence.

Kable JA; Coles CD; Taddeo E. Socio-cognitive habilitation using the math interactive learning experience program for alcohol-affected children. Alcoholism: Clinical and Experimental Research 31(8): 1425-1434, 2007. (90 refs.)

Background: Fetal alcohol syndrome (FAS) has been recognized as a disabling condition with a significant impact on the neurobehavioral functioning of affected individuals, including cognition, behavior, and academic functioning, but little research has been performed on targeted interventions for these children. Methods: A socio-cognitive habilitative program focused on improving behavior and math functioning in children 3 to 10 years of age (n=61) was developed and evaluated. The intervention provided parental instruction on FAS, advocacy, and behavioral regulation via workshops and interactive math tutoring with children. All families received parental instruction and were then randomly assigned to either the math instruction or standard psychoeducational care groups. Results: Satisfaction with workshops was very high, with over 90% agreeing that trainers were knowledgeable and materials easy to understand and helpful. Significant gains in knowledge were found for information provided in the instructional groups. At posttesting, caregivers reported fewer problem behaviors on the Achenbach Child Behavior Checklist, Internalizing Problem Behavior, Externalizing Problem Behavior, and Total Problem Behavior summary scales. After 5 months, both groups of children demonstrated gains in math knowledge but significantly higher gains were found in the group receiving direct math instruction. The math treatment group was also more likely to demonstrate a gain of over 1 standard deviation on any of the 4 math outcome measures used. Conclusions: These findings suggest that parents of children with fetal alcohol spectrum disorders (FAS(D)) benefit from instruction in understanding their child's alcohol-related neurological damage and strategies to provide positive behavioral supports and that targeted psychoeducational programs may be able to remediate some of the math deficits associated with prenatal alcohol exposure.

Kaminer Y; Slesnick N. Evidence-based cognitive-behavioral and family therapies for adolescent alcohol and other substance use disorders. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 383-405. (93 refs.)

While research of adolescent substance abuse treatment is increasing, it still lags behind that of adults. The authors were able to identify 53 empirical studies of treatment outcome for adolescents versus over 1,000 for adults. Recent clinical trials have shown the efficacy of manualized family therapy and cognitive behavioral therapy with adolescents. This chapter reviews the theoretical models that underpin these therapies; provides a literature review of these therapies, and reviews the mechanisms and therapeutic process of family therapy and cognitive-behavioral therapy.

Karno MP. A case study of mediators of treatment effectiveness. Alcoholism: Clinical and Experimental Research 31(10, Supplement S): 33S-39S, 2007. (22 refs.)

Background: Recent research has observed that the use of confrontation in psychosocial treatment for alcohol abuse or dependence has a negative effect on posttreatment alcohol use among patients at average or above average levels of trait anger. It is not known what mediates that negative effect. The current study examines the role of session attendance as a mediator of the effect of confrontation on patients' subsequent alcohol use. In doing so, the study demonstrates the process of testing for mediation as well as planning analyses to meet additional conditions that can lend support to a causal mechanism of change. Methods: Multiple regression analyses were used to test for session attendance as a mediator among 107 individuals with alcohol abuse or dependence who received either cognitive behavioral therapy (CBT) (n = 39), motivational enhancement therapy (MET) (n = 34), or twelve-step facilitation therapy (TSF) (n = 34). Emphasis was placed on achieving the desired temporal sequence of the therapy intervention, the mediator, and the outcome variable. Results: The data supported the role of session attendance as a partial mediator of the effect of confrontation on future alcohol use among patients who received CBT, but not among patients who received MET or TSF. In CBT, other potential mediators (e.g., therapeutic alliance and in-session resistance) were not supported and did not change the support for session attendance in the model. Beyond mediation, some but not all criteria for a causal mechanism of change were also met. Conclusion: This study suggests that in CBT the negative impact of confrontation early in treatment is partially explained by a reduction in the number of sessions patients attended. Different processes appear to be occurring in MET and TSF. By carefully constructing analytic models, results can speak both to issues of mediation and to causal mechanisms of change.

Kayman DJ; Gordon C; Rosenblum A; Magura S. "A Port in a Storm": Client perceptions of substance abuse treatment outreach in a soup kitchen. Journal of Social Work Practice in the Addictions 5(4): 3-25, 2005. (44 refs.)

Substance use is associated with many problems, including homelessness, mental illness, isolation, and poverty, yet ambivalence about change leads many affected individuals to defer treatment or drop out prematurely. This paper describes a manualized, time-limited, low-threshold group model for treatment outreach to residentially unstable drug and alcohol users who, though wanting help, are not yet committed to ending or reducing substance use. The model is based on principles of group work, motivational enhancement, and cognitive-behavioral therapy. Findings from a qualitative analysis of progress notes, illustrated with case studies, tie participant goals to strategies of the treatment model and participant perceptions of the change process

Le Foll B; Melihan-Cheinin P; Rostoker G; Lagrue G; Working Group AFSSAPS. Smoking cessation guidelines: Evidence-based recommendations of the French Health Products Safety Agency. (review). European Psychiatry 20(5-6): 431-441, 2005. (98 refs.)

Tobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.

Ledgerwood DM; McCaul ME; Petry NM. Psychotherapy and pharmacotherapy in treatment of substance use disorders. IN: Kranzler HR; Ciraulo DA, eds. Clinical Manual of Addiction Psychopharmacology. Washington DC: American Psychiatric Press, 2005. pp. 339-356. (112 refs.)

This concluding chapter, following 8 chapters dealing with specific drug classes, addresses the general role of psychotherapy and pharmacotherapy in treating substance use disorders. Specific treatment approaches discussed are brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral couples therapy, and 12-step treatments. The interaction between these psychotherapies and drug therapies is reviewed.

Lekka NP; Lee KH; Argyriou AA; Beratis S; Parks RW. Association of cigarette smoking and depressive symptoms in a forensic population. Depression and Anxiety 24(5): 325-330, 2007. (49 refs.)

The link between mental health issues and smoking has been an important area of investigation. However, little is known about this association in a general adult, male forensic population. The aim of this study was to identify demographic and clinical (depression and anxiety) variables that predict smoking in a forensic population. A large cohort of 353 inmates in a high-security prison underwent a psychiatric interview, including administration of the Montgomery-Asberg Rating Scale for Depression (MADRS) and Hamilton's Rating Scale for Anxiety (HAM-A). Multiple regression analysis suggested that younger age and higher depression scores might predict the amount of daily smoking in this population. In contrast, anxiety symptoms were not an independent predictor for smoking in our study. These findings support the need for additional research to focus on those factors associated with smoking in forensic populations. Psychiatric screening for younger male individuals in forensic settings and targeted cognitive-behavioral interventions to treat depressed smokers may ameliorate the smoking abstinence rate in prisons.

Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. (Chapter refs.)

This volume covers a range of issues related to adolescent substance abuse, including empirically-based treatment development protocols; how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations; culturally based intervention guidelines, and recommendations for practice and policy. This edited book has 21 chapter and 33 contributors. It is organized into five sections. Following an introduction and overview of the volume, Part I considers the theoretical, empirical and methodological foundation for research in adolescent substance abuse treatment. It deals with development issues, recent methodological and statistics advances that can underpin research, and highlights a major research initiative the Cannabis Youth Treatment Intervention, and the preliminary findings. Part II examines the practice and treatment policy trends. There is attention to European research, the Drug Abuse Treatment Outcomes Studies ducted at the UCLA Drug Abuse Research Center, contextual issues that are important in adolescent care, and examines the nature of service organization in England. Part III considers the importance and approaches to comprehensive assessment and integrated treatment planning. Individual chapters consider drug therapies, developmental issues in the diagnosis of co-occurring disorders, and HIV/AIDS prevention in adolescent substance abusers. Part IV addresses evidence-based interventions. Directed initiatives examined are adolescent therapeutic communities, school-based group treatment, family and behavioral interventions, as well as cognitive-behavioral therapy with adolescents substance abuse problems. Part V considers culturally based treatments that have been developed, with a focus on family centered programs created for Native Americans and family-based treatment of Hispanic adolescents. Part VI includes a concluding chapter that examines the strides that have been made while also noting important research questions.

Linden M; Zehner A. The role of childhood sexual abuse (CSA) in adult cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy 35(4): 447-455, 2007. (38 refs.)

Sexual abuse in childhood is a pathogenetic factor for psychological disorders. The attention given to this phenomenon varies between therapists and therapeutic schools. The question is how often sexual abuse is recognized as a problem in cognitive behaviour therapy and how this is related to the present symptoms and therapeutic problems. 1223 case reports, written as application for reimbursement of routine cognitive behaviour therapy, were submitted to a content analysis in respect to childhood sexual abuse. Sexual abuse was mentioned in 10.3% of the cases; 59% of female and 50.0% of male victims were abused by relatives. Sexually abused patients showed significantly increased rates of inadequate care and negative life events during childhood. In comparison to controls, cases showed significantly increased rates of "eating disorders" (15 vs. 6; p <.05), "substance abuse/addiction" (16 vs. 6; p <.05). "suicide attempts" (15 vs. 3; p <.01), "strict refusal of sexual partners" (15 vs. 5; p <.05), "frequently changing partners" (21 vs. 3; p <.001), "problems in marriage/partnership" (95 vs. 77: p <.05) and "sexual problems" (51 vs. 24; p <.001). Childhood sexual abuse is a problem, frequently seen in behaviour therapy patients and therefore also warranting special attention in routine patient care. Sexual abuse is understood by cognitive behaviour therapists as an indicator for traumatizing conditions in general during childhood. It is associated with specific treatment problems and therapeutic needs in adulthood.

Litt MD; Kadden RM; Stephens RS. Coping and self-efficacy in marijuana treatment: Results From the Marijuana Treatment Project. Journal of Consulting and Clinical Psychology 73(6): 1015-1025, 2005. (49 refs.)

This study examined whether a coping-skills-based treatment for marijuana dependence operated by encouraging the use of coping skills or via other mechanisms. Participants were 450 men and women treated in the multisite Marijuana Treatment Project who were randomly assigned to motivational enhancement therapy plus cognitive-behavioral (MET-CB) treatment, motivational enhancement therapy (MET), or a delayed treatment control group. Marijuana use and coping skills were measured at baseline and at follow-ups through 15 months. Results showed that marijuana outcomes were predicted by treatment type and by coping skills use, but that the coping-skills-oriented MET-CB treatment did not result in greater use of coping skills than did the MET treatment. The results suggest that mechanisms of coping skills treatment may need to be reconceptualized.

Longabaugh R. Section 6: Behavioral interventions. (editorial). Journal of Studies on Alcohol Supplement 15: 168-169, 2005. (2 refs.)

Longabaugh R; Zweben A; Locastro JS; Miller WR. Origins, issues and options in the development of the combined behavioral intervention. Journal of Studies on Alcohol Supplement 15: 179-187, 2005. (27 refs.)

Objective: The aim of the investigators was to develop a moderate intensity comprehensive behavioral treatment based on the principles of motivational interviewing and Cognitive Behavioral Therapy that, within the confines of a standardized abstinence-oriented treatment, would provide a broad spectrum of modules to assist those seeking treatment to achieve reduction of problematic drinking. Method: The core issue of how to deliver a flexible therapy tailored to the needs of individual clients while at the same time providing a standardized treatment protocol for a randomized clinical trial provided the dilemma out of which this unique standardized protocol arose. By using a single decision tree, client choice, combined with limited options, we were able to reconcile these conflicting demands. Results: Key decisions that were made in developing the treatment protocol and the thinking leading to these decisions are described. Conclusions: Understanding these key issues and the factors that led to the decisions made will assist would-be users in their own clinical and/or clinical research needs.

McKee SA; Carroll KM; Sinha R; Robinson JE; Nich C; Cavallo D; O'Malley S. Enhancing brief cognitive-behavioral therapy with motivational enhancement techniques in cocaine users. Drug and Alcohol Dependence 91(1): 97-101, 2007. (30 refs.)

Background: We investigated the impact of enhancing brief cognitive-behavioral therapy with motivational interviewing techniques for cocaine abuse or dependence, using a focused intervention paradigm. Methods: Participants (n = 74) who met current criteria for cocaine abuse or dependence were randomized to three-session cognitive-behavioral therapy (CBT) or three-session enhanced CBT (MET+ CBT), which included an initial session of motivational enhancement therapy (MET). Outcome measures included treatment retention, process measures (e.g., commitment to abstinence, satisfaction with treatment), and cocaine use. Results: Participants who received the MET+ CBT intervention attended more drug treatment sessions following the study interventions, reported significantly greater desire for abstinence and expectation of success, and they expected greater difficulty in maintaining abstinence compared to the CBT condition. There were no differences across treatment conditions on cocaine use. Conclusions: These findings offer mixed support for the addition of MET as an adjunctive approach to CBT for cocaine users. In addition, the study provides evidence for the feasibility of using short-term studies to test the effects of specific treatment components or refinements on measures of therapy process and outcome.

Meyers RJ; Miller WR, eds. A Community Reinforcement Approach to Addiction Treatment. Cambridge: Cambridge University Press, 2006. (Book refs.)

This edited work, organized into nine chapters and with 10 contributors, is a revision of a previous volume. It presents the Community Reinforcement Approach (CRA), a broad-spectrum cognitive-behavioral treatment for substance use disorders. At the core of CRA is the belief that an individual's environment can play a powerful role in encouraging or discouraging drinking and drug use. Consequently, it attempts to rearrange contingencies so that sober behavior is more rewarding than substance-abusing behavior. Originally tested in the early 1970s with a small sample of alcohol-dependent inpatients, it has repeatedly proven to be successful over the years with larger, diverse populations. The initial chapters deal with the development of the CRA approach, the early Azrin studies demonstrating its efficacy, also provide a detailed description of the treatment approach, including basic guidelines for clinicians, communication skills, problem-solving and drink-refusal strategies. CRA is then compared to other forms of treatment with a new chapter devoted to the finding from a controlled trial of CRA and traditional treatment. The final chapters discuss the application to special populations: the homeless, those with cocaine and opiate dependencies, and its application to family members [Community Reinforcement and Family Training (CRAFT)] followed by a summary chapter.

Miller WR; Carroll KM, eds. Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It. New York: Guilford Press, 2006. (Chapter refs.)

Several years ago one author lamented that the research being conducted on "change" within the substance abuse field was 'mis-directed.' The core problem he stated was not a lack of understanding about how clients change, but the absence of knowledge about how clinicians change, i.e. and what will enable them to adopt best practices. This volume is intended to deal with the conundrum. This book has the goal of describing what treatment and prevention would look like were they based on the best science available. It presents key information from the current substance abuse research in a practical fashion to promote better clinical care. This volume, organized into 18 chapter with 28 contributors, is organized into five section. The first section deals with the field's failure to utilize best practices, the increasing understanding of essentially complex phenomenon related to drug use/abuse, and outlines the goals for the book. Section II considers the neurobiology of addiction, the insights provided by brain imaging in respect to risk factors and relapse, as well as the genetic factors related to substance use and abuse. Section III considers psychological factors. It includes examination of the phenomenon of natural change, change in the absence of treatment. It reviews the relationship of substance use and co-occurring psychological problems. Another chapter also summarizes the insights into developmental factors that play a role in the development of substance abuse problems. Section IV turns to examination of social factors. The domains considered are the presence of race and gender differences, the impact of family and close relationships, the impact of social context, as well as the insights provided by ethnographic and anthropological studies. Section V is devoted to intervention. Beyond consideration of specific modalities, such as behavior therapies and drug therapies, a domain less discussed, religion and spirituality is also examined. In this section the limitations of the current treatment system are also considered. The concluding chapter sets forth ten principles and ten recommendations.

Moeller FG; Schmitz JM; Steinberg JL; Green CM; Reist C; Lai LY et al. Citalopram combined with behavioral therapy reduces cocaine use: A double-blind, placebo-controlled trial. American Journal of Drug and Alcohol Abuse 33(3): 367-378, 2007. (40 refs.)

Cocaine dependence continues to be a significant problem in the United States, without any approved pharmacotherapy. Promising findings from preclinical research on the effects of cocaine on serotonin lead to examination of selective serotonin reuptake inhibitors (SSRIs) as potential treatments for cocaine dependence with mixed results, possibly due to drug interactions or specifics of concomitant behavioral therapy. The purpose of this study was to examine whether the SSRI citalopram would reduce cocaine positive urines in a 12-week, double-blind placebo-con trotted trial. Seventy-six cocaine dependent patients received either citalopram 20mg per day or placebo along with cognitive behavioral therapy (CBT) and contingency management (CM). Citalopram treated subjects showed a significant reduction in cocaine-positive urines during treatment compared to placebo treated subjects. No differences were noted in retention between the two groups.

Ness ML; Oei TPS. The effectiveness of an inpatient group cognitive behavioral therapy program for alcohol dependence. American Journal on Addictions 14(2): 139-154, 2005. (34 refs.)

The present study evaluated the effectiveness of attendance at a clinically based, short-term, in-patient group CBT program largely based on Monti, Abrams, Kadden, and Cooney(1) to treat problem drinking. Participants were 37 males and 34 females diagnosed with alcohol dependence. Patients attended 42 CBT sessions over three weeks, with each session being one hour in duration. Measures included the Khavari Alcohol Test (KAT), the Short Alcohol Dependence Data Questionnaire (SADD), the Beck Anxiety Index (BAI), the Symptom Checklist-90-Revised (SCL-90), a General Self-Efficacy scale (GSE), and the Drinking Expectancy Profile (DEP). Group attendance rates were monitored daily. Two structured phone calls were conducted at one month and three months post-discharge. Results showed that attendance rates at CBT group sessions were not associated with improvements found at the end of therapy or in drinking behaviors at three-month follow-up. Full support could not be found for the effectiveness of group CBT and cognitive models of problem drinking.

Olmstead TA; Sindelar JL; Easton CJ; Carroll KM. The cost-effectiveness of four treatments for marijuana dependence. Addiction 102(9): 1443-1453, 2007. (41 refs.)

Aim: To analyze data from a randomized clinical trial to determine the cost-effectiveness of using contingency management (CM) and motivational/skills building therapy (motivational enhancement therapy/cognitive-behavioral therapy: MET/CBT) to treat young adults with marijuana dependence. Participants, design and measurements A total of 136 marijuana-dependent young adults, all referred by the criminal justice system, were randomized to one of four treatment conditions: MET/CBT with CM, MET/CBT without CM, drug counseling (DC) with CM and DC without CM. Patient outcome measures include the longest duration of confirmed marijuana abstinence (LDA) during treatment and the total number of marijuana-free urine specimens provided during treatment. Costs were collected retrospectively from the provider and include the costs of therapy, patient drug testing, and those associated with the incentives component (value of vouchers, time to administer the voucher system). Settings: Out-patient substance abuse clinic in New Haven, Connecticut. Findings: Which treatment is the most cost-effective depends on the threshold values of an additional week of LDA or an additional marijuana-free urine specimen. For example, the most effective treatment, MET/CBT with CM, was also the most cost-effective treatment at the highest threshold values, while the least effective treatment, DC, was the most cost-effective at the lowest values. Because consensus threshold values for these patient outcomes do not exist, results are presented showing the ranges of values over which each treatment would be considered cost-effective compared to the others. Acceptability curves are presented to show the decision uncertainty associated with these ranges. The results are shown to be robust to (i) sensitivity analyses on several key cost parameters and (ii) patient outcomes measured during the 6-month follow-up period. Conclusions: This study uses incremental cost-effectiveness ratios and acceptability curves to shed light on the relative cost-effectiveness of four interventions for treating young adults with marijuana dependence. Given the relatively small and specialized nature of our study sample, and the fact that we examined a CM procedure with a single reinforcement schedule, additional studies are warranted to determine the reliability and generalizability of our results both to alternative marijuana-using populations and to CM procedures with alternative incentive parameters. Nevertheless, the relative durability of effects of MET/CBT compared to DC through the 6-month follow-up, and its cost-effectiveness over a comparatively wide range of threshold values, underscores the promise of this approach.

O'Malley SS; Sinha R; Grilo CM; Capone C; Farren CK; Mckee SA et al. Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 31(4): 625-634, 2007. (64 refs.)

Background: Despite important gender differences in drinking patterns, physiological effects of alcohol, and co-occurring psychiatric conditions, relatively little is known about the efficacy of naltrexone for the treatment of alcohol dependence in women. This study investigated the safety and efficacy of naltrexone in combination with Cognitive Behavioral Coping Skills Therapy (CBCST) in a sample of alcohol-dependent women, some with comorbid eating pathology. Methods: One hundred three women meeting DSM-IV criteria for alcohol dependence (29 with comorbid eating disturbances) were randomized to receive either naltrexone 50 mg or placebo for 12 weeks in addition to weekly group CBCST. Subjects were enrolled between October 1995 and December 2000 at an outpatient research clinic. Results: No significant differences were observed on the primary outcomes of time to first drinking day, time to first day of heavy drinking, or the percentage of participants who continued to meet the criteria for alcohol dependence. Secondary analyses revealed that naltrexone significantly delayed the time to the second (chi(2)=5.37, p=0.02) and third (chi(2)=4.35, p=0.04) drinking days among subjects who did not maintain abstinence from alcohol. Among those with eating disturbances, symptoms of eating pathology improved during treatment, but the effects did not differ according to medication condition. Conclusions: When used in conjunction with CBCST, naltrexone did not significantly improve drinking outcomes in the overall sample of alcohol-dependent women. However, naltrexone may be of benefit to women who are unable to maintain total abstinence from alcohol. For women with concurrent eating pathology, participation in treatment for alcoholism may be associated with improvements in eating pathology.

Otto MW; Bruce SE; Deckersbach T. Benzodiazepine use, cognitive impairment, and cognitive-behavioral therapy for anxiety disorders: Issues in the treatment of a patient in need. Journal of Clinical Psychiatry 66(Supplement 2): 34-38, 2005. (48 refs.)

Cognitive-behavioral therapy (CBT) is effective in the treatment of anxiety disorders when used in conjunction with benzodiazepine pharmacotherapy and when used as a monotherapy. Patients using CBT alone have dropout rates similar to or lower than those patients undergoing other forms of therapy, including benzodiazepines. CBT also works well with patients who do not respond adequately to pharmacotherapy. Combined CBT and benzodiazepine treatment has additive effects when compared with benzodiazepine monotherapy; however, patients receiving combined therapy who subsequently discontinue benzodiazepine treatment experience a loss of efficacy compared with CBT and placebo, perhaps due to fear extinction being context dependent. To avoid this loss of efficacy, CBT may be administered alone or as a bridge between benzodiazepine use and discontinuation during a medication taper. The case report upon which this supplement is based questions the value of CBT for patients experiencing cognitive impairment due to an anxiety disorder, benzodiazepine medication, substance abuse, or a combination of these factors. This article addresses this concern and asserts that CBT is a valuable treatment option in these cases.

Pelissier B; Jones N. Differences in motivation, coping style, and self-efficacy among incarcerated male and female drug users. Journal of Substance Abuse Treatment 30(2): 113-120, 2006. (73 refs.)

This study compared sex differences in theoretically relevant cognitive-behavioral treatment concepts in a sample of 1,189 male and 300 female offenders participating in a prison-based substance abuse treatment program. Multivariate analysis of variance was used to examine the differences between men and women in the areas of motivation, self-efficacy, and coping styles. The results show that the women reported a greater recognition of having a substance use problem, less self-efficacy to remain abstinent in high-risk situations, and greater reliance on the coping strategies of seeking support, accepting responsibility, and escaping as compared with the men. The recognition of potential sex differences in the context of a theoretically driven treatment for substance users is discussed.

Rawson RA; McCann MJ; Flammino F; Shoptaw S; Miotto K; Reiber C et al. A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction 101(2): 267-274, 2006. (34 refs.)

Aims: Previous research has reported that both contingency management (CM) and cognitive-behavioral therapy (CBT) are efficacious interventions for the treatment of stimulant abusers. The present study sought to directly compare the effectiveness of (CM) and (CBT) alone and in combination in reducing stimulant use. Design: Randomized clinical trial. Participants Stimulant-dependent individuals (n = 171). Intervention CM, CBT or combined CM and CBT, 16-week treatment conditions. CM condition participants received vouchers for stimulant-free urine samples. CBT condition participants attended three 90-minute group sessions each week. Measurements: Participants were interviewed at baseline and weeks 17, 26 and 52. Measures included psychiatric disorders and alcohol and drug use and concomitant social problems. Findings CM procedures produced better retention and lower rates of stimulant use during the study period. Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups and urinalysis data did not differ between groups at follow-up. While CM produced robust evidence of efficacy during treatment application, CBT produced comparable longer-term outcomes. There was no evidence of an additive effect when the two treatments were combined. Conclusions: This study suggests that CM is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach. CM is useful in engaging substance abusers, retaining them in treatment and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.

Richmond RL; Butler T; Belcher JM; Wodak A; Wilhelm KA; Baxter E. Promoting smoking cessation among prisoners: Feasibility of a multi-component intervention. Australian and New Zealand Journal of Public Health 30(5): 474-478, 2006. (15 refs.)

Objective: To conduct a pilot study to determine the feasibility and effectiveness of a multi-component smoking cessation intervention among prison inmates. Methods: A prospective study conducted within a maximum-security prison located near Sydney, New South Wales, and housing around 330 men. Participants received a smoking cessation intervention with six-month follow-up to determine abstinence. The smoking cessation intervention consisted of two brief cognitive behavioural therapy sessions, nicotine replacement therapy, bupropion and self-help resources. Point prevalence and continuous abstinence at follow-up were verified with expired carbon monoxide measures. Results:Thirty male inmates participated in the intervention. At six months, the biochemically validated point prevalence and continuous abstinence rates were 26% and 22% respectively. Reasons for relapse to smoking included: transfers to other prisons without notice, boredom, prolonged periods locked in cells, and stress associated with family or legal concerns. Those inmates who relapsed, or continued to smoke following the intervention, smoked less tobacco than at baseline and 95% stated they were willing to try to quit again using our intervention. Conclusions: Prison inmates are able to quit or reduce tobacco consumption while in prison but any smoking cessation intervention in this setting needs to address prison-specific issues such as boredom, stress, transfers to other prisons, court appearances, and isolation from family and friends. Implications: The prevalence of smoking within Australian prisons is alarmingly high. Further work into how to encourage prisoners to quit smoking is required.

Richmond RL; Kehoe L. Ten-year survival outcome of the nicotine transdermal patch with cognitive behavioural therapy. Australian and New Zealand Journal of Public Health 31(3): 282-285, 2007. (23 refs.)

Objective: To follow-up abstainers from the end of their initial treatment over seven points to 10 years. Methods: In the original study there were 305 smokers who were recruited in a double-blind randomised controlled trial. Those subjects who had remained continuously abstinent to seven years (n=20) were followed up to ascertain continuous smoking prevalence to 10 years. Main outcome measure was continuous abstinence. Results: At 10 years, the active nicotine patch group showed significantly higher continuous abstinence rates that were double those of the placebo group (7.9% vs. 2.6%, respectively). The high rate of relapse declined after six months. Conclusions: The nicotine patch leads to superior continuous abstinence over 10 years when compared with placebo. Public health implications: This is the longest follow-up study of continuous smoking abstinence after cognitive behaviour treatment combined with the nicotine patch.

Roffman RA; Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. London: Cambridge University Press, 2006. (Chapter refs.)

Cannabis is the most widely used illicit drug in the U.S. In respect to public policy, there are a number of questions that have been raised, from review of its legal status, with some proposing legalization or de-criminalization of small quantities, to making provision for medical use for those with chronic illness. There has also been increasing research on cannabis, its relationship to the emergence of schizophrenia, to clarification of the existence and nature of withdrawal phenomenon with abstinence after long-term heavy use. This edited volume, with 15 chapters and 26 contributors, is intended as a comprehensive review of cannabis use, the associated problems, and related policy questions. It is organized into five parts. The first part deals with cannabis dependence: the pharmacological basis, epidemiology, diagnosis, and associated medical and psychological morbidity. Part II considers interventions with cannabis dependent adults. Five different approaches are reviewed: cognitive-behavioral and motivational enhancement therapies, contingency-management, the marijuana check-up, guided self-change (a brief motivational technique), and supportive-expressive psychotherapy. Part III addresses interventions with cannabis-dependent adolescents and young adults. One chapter reviews the findings and treatment models from the 'Cannabis Youth Treatment Study', another describes the teen cannabis check-up and strategies for reaching young marijuana users, and another deals with probation-referred cannabis-abusing young adults. Part IV is directed to the policy implications of cannabis dependence; and Part V deals with the implications for research and policy.

Roozen HG; Van Beers SEC; Weevers HJA; Breteler MHM; Willemsen MC; Postmus PE et al. Effects on smoking cessation: Naltrexone combined with a cognitive behavioral treatment based on the Community Reinforcement Approach. Substance Use & Misuse 41(1): 45-60, 2006. (35 refs.)

A promising option in substance abuse treatment is the Community Reinforcement Approach (CRA). The opioid antagonist naltrexone (NTX) may work in combination with nicotine replacement therapy (NRT) to block the effects of smoking stimuli in abstinent smokers. Effects of lower doses than 50 mg/dd. have not been reported. A study was conducted in Amsterdam in 2000/2001 with the objective to explore, the effects of the combination NTX (25/50-mg dd.), NRT, and CRA in terms of craving and abstinence. hi a randomized open label, 2 x 2 between subjects design, 25 recovered spontaneous pneumothorax (SP) participants received 8 weeks of treatment. Due to side effects, only 3 participants were compliant in the 50-mg NTX condition. Craving significantly declined between each measurement and there was a significant interaction between decline in craving and craving measured at baseline. The abstinence rate in the CRA group was nearly double that in the non-psychosocial therapy group (46% vs. 25%; NS) at 3 months follow-up after treatment.

Roozen HG; van de Wetering BJM. Neuropsychiatric insights in clinical practice: From relapse prevention toward relapse management. American Journal on Addictions 16(6): 530-531, 2007. (7 refs.)

The article discusses the significance of the development of relapse prevention (RP) programs toward relapse management on neuropsychiatry. The RP programs are widely used comprehensive set of cognitive behavioral techniques to assist the patient to prevent relapse in addictive behaviors. Its principles assume that addictive behaviors are a habitual product of immediate gratifications and delayed negative consequences. It is recommended to maintain motivation and treatment compliance and to change the term relapse prevention to relapse management to achieve an improved and more accurate treatment fit of controlling the frequency and severity of relapses.

Rosenblum A; Cleland C; Magura S; Mahmood D; Kosanke N; Foote J. Moderators of effects of motivational enhancements to cognitive behavioral therapy. American Journal of Drug and Alcohol Abuse 31(1): 35-58, 2005. (65 refs.)

Patient treatment matching hypotheses were tested for substance users randomly assigned to a group cognitive behavioral therapy (CBT; n = 114) or a group motivational intervention (GMI; n = 116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15-week follow-up, the study predicted that alexithymia, antisocial personality disorder (ASPD), and network support for alcohol and drug use would be associated with less substance use for CBT subjects and that hostility and lower treatment motivation would be associated with less substance use for GMI subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and ASPD. Results indicate the use of assessing specific patient attributes to better inform treatment recommendations.

Rosenbloom MJ; O'Reilly A; Sassoon SA; Sullivan EV; Pfefferbaum A. Persistent cognitive deficits in community-treated alcoholic men and women volunteering for research: Limited contribution from psychiatric comorbidity. Journal of Studies on Alcohol 66(2): 254-265, 2005. (61 refs.)

Objective: The contribution of psychiatric comorbidity to cognitive status was assessed in a sample of treatment-seeking alcoholics who met criteria to participate in studies of effects of chronic alcohol misuse on brain structure and cognition. Method: Alcoholic men (n = 43) and women (n = 21) who responded to notices about a research study were screened, clinically assessed and administered Wechsler Memory and Intelligence tests after 3 months of sobriety, on average. Cognitive performance was compared with that of an age-matched sample of healthy controls (n = 51). Results: As a group, the alcoholics achieved significantly lower scores than controls on summary indices of the Wechsler Memory and Adult Intelligence Scales and showed greater decline from estimated premorbid intelligence levels than controls. Almost 60% of the alcoholics had at least one additional psychiatric (mood or anxiety) or past substance-dependence comorbidity. There were no marked sex differences in patterns of comorbidity. Comorbid alcoholics were younger, had consumed less alcohol over their lifetime and performed between noncomorbid alcoholics and controls on all tests. Conclusions: Mood and anxiety comorbidity did not necessarily compound poor cognitive test performance associated with chronic alcohol misuse. While unexpected, this finding suggests that, in this sample, poorer cognitive performance was more a function of alcoholism per se than nonalcoholic comorbidity.

Rowan-Szal GA; Bartholomew NG; Chatham LR; Simpson DD. A combined cognitive behavioral intervention for cocaine-using methadone clients. Journal of Psychoactive Drugs 37(1): 75-84, 2005. (54 refs.)

Treating cocaine use by opiate-dependent clients in methadone programs is a well documented challenge. Both behavioral (contingency management) and cognitive (relapse prevention) interventions have shown promise in helping engage these clients in treatment. In this study, the effectiveness of combining contingency management with a cocaine-specific relapse prevention counseling module was examined. Sixty-one cocaine-using methadone clients were randomly assigned to one of four treatment conditions to participate in the eight-week intervention and eight-week follow-up period. Using analysis of variance (ANOVA), differences in cocaine use and treatment retention were examined. Contingency management was significantly related to reductions in cocaine use and the counseling module was positively related to six-month retention rates. Both interventions were associated with positive treatment response but the effects were reflected in different behavioral outcomes.

Rychtarik RG; McGillicuddy NB. Coping skills training and 12-step facilitation for women whose partner has alcoholism: Effects on depression, the partner's drinking, and partner physical violence. Journal of Consulting and Clinical Psychology 73(2): 249-261, 2005. (55 refs.)

Women (N = 171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism.

Scherbaum N; Kluwig J; Specka M; Krause D; Merget B; Finkbeiner T; Gastpar M. Group psychotherapy for opiate addicts in methadone maintenance treatment: A controlled trial. European Addiction Research 11(4): 163-171, 2005. (22 refs.)

A controlled trial was conducted evaluating cognitive-behavioural group psychotherapy as a measure to reduce concomitant drug use in methadone maintenance treatment (MMT). 73 opiate addicts were randomly assigned to local routine MMT or to routine MMT plus group psychotherapy (20 sessions over 20 weeks). Psychotherapy was delivered by therapists according to a manual. Drug use (urine screen) was compared at onset of psychotherapy, end of intervention period (6 months after study onset), and 6 months later. Data analysis was done according to intention-to-treat principles. Results indicated that patients in the psychotherapy group (n = 41) showed less drug use than control subjects (n = 32). This group difference was statistically significant at 6-month follow-up (p = 0.02). These findings underscore the usefulness of group psychotherapy in MMT. The delayed effect is comparable to other studies evaluating cognitive-behavioural psychotherapy.

Schmitz JM; Stotts AL; Mooney ME; DeLaune KA; Moeller FG. Bupropion and cognitive-behavioral therapy for smoking cessation in women. Nicotine & Tobacco Research 9(6): 699-709, 2007. (67 refs.)

Gender data for bupropion suggest that it may be a particularly effective smoking cessation medication for women. It is not known whether the efficacy of this pharmacotherapy differs as a function of the psychotherapy with which it is administered. This study used a two level factorial design to examine the independent and interactive effects of medication (bupropion 300mg/day vs. placebo) and psychotherapy (cognitive-behavioral therapy JCBTJ Vs. supportive therapy [ST]). In addition to testing the hypothesis that bupropion with CBT would be most effective of all the treatments, we examined medication compliance and its role in the efficacy of bupropion. Participants were 154 women, aged at least 30 years and smoking more than 10 cigarettes/day. Compliance with study medication was assessed using Medication Event Monitoring Systems (MEMS) over 7 weeks of treatment. Psychological interventions were delivered in 60-min weekly group sessions. Longitudinal analysis of abstinence outcomes from end of treatment (EOT) through 12 months after treatment revealed a significant interaction of medication and therapy. Higher abstinence rates at EOT and 3-, 6-, 9-, and 12-month follow-ups were observed when bupropion was delivered concurrently with CBT (44%, 24%, 30%, 23%, 17%) rather than with ST (18%, 1%, 8%, 5%, 2%). The bupropion-CBT combination, however, was not clearly superior to placebo, regardless of therapy assignment. Higher rates of medication compliance were positively predictive of abstinence, and this effect was most evident in the placebo condition. Findings provide only modest support for CBT as the preferred type of intensive therapy in conjunction with bupropion in women.

Schnoll RA; Rothman RL; Wielt DB; Lerman C; Pedri H; Wang H et al. A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients. Annals of Behavioral Medicine 30(1): 1-11, 2005. (99 refs.)

Background: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking. Purpose: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation. Methods: Cancer patients (N = 109) were randomized to either the theoretically based CBTintervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy. Results: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either 1-month (44.9% vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation. Conclusions: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions forfuture research in this area.

Schoenmakers T; Wiers RW; Jones BT; Bruce G; Jansen ATM. Attentional re-training decreases attentional bias in heavy drinkers without generalization. Addiction 102(3): 399-405, 2007. (44 refs.)

Aims: To examine whether alcohol-related attentional bias (AB) can be reduced by training heavy drinkers to attend to soft drinks as an alternative to alcohol. Diminishing AB is important because AB has been suggested to be a significant factor in the development, maintenance and relapse of addictive behaviours. AB was trained in a clinically relevant design, and we studied the generalization of this training. Design, participants and intervention: We assigned randomly 106 heavy drinking male college and university students to the attentional re-training (AR; modified visual-probe task) or control condition (standard visual-probe task). Setting: Laboratory at Maastricht University. Measurements: We measured the effects of AR on the visual-probe task with stimuli that were presented in the AR and with new stimuli, and on an alternative measure of AB, the flicker paradigm. We further measured effects on craving and preference for either an alcohol beverage or a soft drink. Findings After AR, participants had learned to avoid alcohol stimuli and had developed an AB for soft drinks. This effect was restricted to stimuli used in the AR. The flicker task, where AB for alcohol was found in both the AR and control groups, was not affected by the AR. No effect was found on craving and the preference task. Conclusions: Although heavy drinkers can learn to attend selectively to an alternative category for alcohol, a single AR is not sufficient to decrease symptoms of problem drinking.

Shoptaw S; Reback CJ; Peck JA; Yang XW; Rotheram-Fuller E; Larkins S et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence 78(2): 125-134, 2005. (50 refs.)

Background: Methamphetamine-dependent gay and bisexual men (GBM) are at high risk for HIV transmission, largely due to drug-associated sexual risk behaviors. This project evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors among this population. Methods: In this randomized controlled trial, 162 methamphetamine-dependent (SCID-vefified) GBM in Los Angeles County were randomly assigned to one of four treatment conditions for 16 weeks: standard cognitive behavioral therapy (CBT, n = 40), contingency management (CM, n = 42), combined cognitive behavioral therapy and contingency management (CBT + CM, n = 40), and a culturally tailored cognitive behavioral therapy (GCBT, n = 40). Stimulant use was assessed thrice-weekly during treatment using urine drug screens (48 measures). Sexual risk behaviors were monitored monthly (four measures). Follow-up assessments were conducted at 6 (80.0%) and 12 months (79.9%). Results: Statistically significant differences in retention (F(3,158) = 3.78, p < .02), in longest period of consecutive urine samples negative for methamphetamine metabolites (F(3,158) = 11.80, p < .001), and in the Treatment Effectiveness Score were observed by condition during treatment (F(3,158) = 7.35, p< .001) with post hoc analyses showing the CM and CBT + CM conditions to perform better than standard CBT. GEE modeling results showed GCBT significantly reduced unprotected receptive anal intercourse (URAI) during the first 4 weeks of treatment (chi (2) = 6.75, p< .01). During treatment between-group differences disappeared at follow-up with overall reductions in outcomes sustained to 1-year. Conclusions: Among high-risk methamphetamine-dependent GBM, drug abuse treatments produced significant reductions in methamphetamine use and sexual risk behaviors. Drug abuse treatments merit consideration as a primary HIV prevention strategy for this population.

Smith MT; Huang MI; Manber R. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. (review). Clinical Psychology Review 25(5): 559-611, 2005. (118 refs.)

Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-1 is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-1 to disease specific conditions and symptoms.

Stephens RS; Roffman RA; Copeland J; Swift W. Cognitive behavioral and motivational enhancement treatments. IN: Roffman RA; Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. London: Cambridge University Press, 2006. pp. 132-154

This chapter outlines two of the major interventions used with cannabis dependence. These are cognitive behavior therapy and motivational-enhancement therapy. The key elements of each of these is set forth, and how they can be used in tandem is described. Both individual and group treatment programs are considered, their relative strengths, and the basis for selecting one over the other is outlined. Broad general issues related to treatment of cannabis dependence is considered. Also, treatment outcome and mechanisms which seem to be related to change are addressed.

Stewart SH; Conrod PJ; Marlatt GA; Comeau MN; Thush C; Krank M. New developments in prevention and early intervention for alcohol abuse in youths. Alcoholism: Clinical and Experimental Research 29(2): 278-286, 2005. (44 refs.)

This article summarizes a symposium held at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, British Columbia, Canada. It was prepared by the conference co-organizers/co-chairs with substantial input from each of the symposium participants. Increasingly, alcohol abuse interventions focus on preventing alcohol problems or intervening early before risky drinking behavior becomes ingrained. Universal prevention programs have produced no or only modest effects on the drinking behavior of youths. Although some existing targeted prevention programs have proved effective, they have not tapped the full range of potential intervention targets, such as the underlying motivations for alcohol misuse in youths who are at greatest risk. The set of papers presented in this symposium outline exciting new developments in the field of targeted prevention and early intervention programs for adolescent drinking problems, presented by an international panel of researchers. These developments include attention